Comparison of single-dose radial extracorporeal shock wave and local corticosteroid injection for treatment of carpal tunnel syndrome including mid-term efficacy: a prospective randomized controlled trial

Abstract

BackgroundRecent studies have reported that radial extracorporeal shock wave therapy (rESWT) reduces pain and improves function in patients with mild to moderately severe carpal tunnel syndrome (CTS) compared to a placebo. However, most of those studies used multi-session rESWT combined with wrist support and evaluation of efficacy was limited to a maximum of 14 weeks.MethodsThe prospective randomized controlled trial compared efficacy in relieving pain and improving clinical function between single-dose rESWT and local corticosteroid injection (LCsI) over the mid-term (24 weeks). Twenty-five patients with mild to moderately severe CTS were randomized to receive either single-dose rESWT (n = 13) or LCsI (n = 12). Primary outcomes were evaluated using the Boston self-assessment questionnaire (BQ), while secondary outcomes used the Visual analogue scale (VAS) and electrodiagnostic parameters. Evaluations at baseline and at 1, 4, 12 and 24 weeks after treatment were performed.ResultsThere was significantly greater improvement in symptom severity scores, functional scores and Boston questionnaire scores at weeks 12 to 24 in the rESWT group compared to the LCsI group. When compared to the baseline, there was significant reduction of VAS and functional score in the rESWT group at weeks 12 and 24. The LCsI group had no statistically significant differences in VAS reduction and functional score of the same period.ConclusionsTreatment of CTS using single-dose rESWT has a carry-over effect lasting up to 24 weeks suggesting that single-dose rESWT is appropriate for treatment of mild to moderate CTS and provides longer-lasting benefits than LCsI.Trial registration(TCTR20150709001). Registered 9 July 2015

Effectiveness of Conservative Treatment According to Severity and Systemic Disease in Carpal Tunnel Syndrome: A Systematic Review

“…Of these, 28 articles assessed patients with idiopathic CTS, 2 also assessed patients with hypertension and diabetes [ 21 , 22 ] and only 1 article assessed strictly diabetic patients [ 23 ]. Additionally, all the studies include mild and moderate severity of CTS, and 8 studies included severe CTS patients [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 ].…”

“…Six studies observed the effectiveness of drugs [ 29 , 32 , 33 , 34 , 35 , 36 ]; eight studies evaluated the effectiveness of electrotherapy [ 21 , 22 , 25 , 37 , 38 , 39 , 40 , 41 ] (diathermy, shock waves, radiofrequency, and so on); and eight studies the effect of manual therapy [ 26 , 27 , 28 , 42 , 43 , 44 , 45 , 46 ]. Three studies compared electrotherapy and a drug intervention [ 24 , 47 , 48 ] and two studies compared electrotherapy and manual therapy [ 23 , 30 ]. Two articles differed from these categories: one study analyzed the effectiveness of an alternative therapy (lavender ointment) [ 49 ] and the other one, a thermal agent (paraffin wax) [ 50 ].…”

“…Two articles differed from these categories: one study analyzed the effectiveness of an alternative therapy (lavender ointment) [ 49 ] and the other one, a thermal agent (paraffin wax) [ 50 ]. Twelve studies had a control group [ 22 , 25 , 27 , 28 , 33 , 41 , 42 , 43 , 44 , 45 , 46 ]; nine studies a placebo group [ 21 , 29 , 37 , 38 , 39 , 40 , 42 , 48 , 49 ]; and thirteen studies an alternative treatment [ 23 , 24 , 26 , 27 , 30 , 32 , 34 , 35 , 36 , 37 , 39 , 47 , 48 ]. There were six articles having three or more groups [ 27 , 32 , 37 , 39 , 42 , 48 ].…”

Effect of extracorporeal shockwave therapy on carpal tunnel syndrome

“…The full text articles were read, and 6 were considered relevant by qualitative analysis. [19,20,21,22,23,24] Studies selected for final inclusion (or exclusion) are shown in Figure 1, and the characteristics of the included studies are summarized in Table 1. In terms of quantitative analysis, these 6 studies (published from 2013 to 2018) fulfilled our inclusion criteria.…”

“…Interestingly, Ke et al [20] compared a single session ESWT of 2000 shocks to a protocol using ESWT in 3 sessions, and showed a cumulative effect of ESWT on CTS. Atthakomol et al used a single session ESWT of 5000 shocks to improve patient compliance and reported a significant effect [19] . We tried to determine the dose-response of ESWT through a meta-regression analysis.…”